APPLICANT'S ABSTRACT: This proposal is directed toward an understanding of alcohol treatment services under managed care. It seeks to examine the characteristics of benefit structures and how these and other management variables lead to alcohol service consumers who are either well served or under served as a result. Three indicators of alcohol treatment services will be studied: access, consumer satisfaction, and outcomes. The study also will carefully describe alcohol treatment episodes and how they vary with gender, race and age group. To accomplish these study objectives, the programs of one of the largest managed mental health companies in the United States, Green Spring Health Services will be examined in some detail. Examining one provider in some detail eliminates problems associated with mixing incompatible records systems from different companies as well as simplifying project coordination. The three indicators of care will be studied in three separate but mutually supportive studies. In the first study, claims and treatment authorization data for all alcohol treatment services over a multiple year period will be examined. The purpose is to examine the relationship between benefit structure variables, management strategy, and the utilization and cost (measured by total medical payments, or in the case of staff model care, by production cost) of alcohol treatment. A second small study will analyze previously collected patient satisfaction data by alcohol treatment service modality. The satisfaction data, representing reported access, care, communication with provider, and outcome perceptions, will allow for an examination of these perceptions of care as a function of management strategy, benefit structure, utilization, and cost. The third study is a prospective examination of alcohol treatment outcomes using the Alcohol Outcomes Module which provides for patient baseline, clinician baseline, patient follow-up, and-records review. Alcohol treatment clients in one of Green Spring's large local operating units will be studied over a 24 month period of intake. Six month outcome data will allow for a study or outcome as a function of authorization utilization, and cost of services and by the benefit structure, such as patient co-payments. This study also will explore treatment use that was not covered by the plan and will probe the effect of racially matching patients with providers.